RESUMEN
Routine laboratory screening is typically performed at initial evaluation of the vast majority of presentations to the emergency department (ED). These laboratory results are crucial to the diagnostic process, as they may influence up to 70% of clinical decisions. However, despite the usefulness of biological assessments, many tests performed are inappropriate or of doubtful clinical relevance. This overutilization rate of laboratory testing in hospitals, which represents a significant medical-economic burden, ranges from 20 to 67%, with coagulation tests at the top of the list. While reviews frequently focus on nonintensive care units, there are few published assessments of emergency-specific interventions or guidelines/guidance to date. The aim of this review is to highlight current recommendations for hemostasis evaluation in the emergency setting with a specific analysis of common situations leading to ED admissions, such as suspected venous thrombosis or severe bleeding. We revisit the evidence related to the assessment of patient's hemostatic capacity based on comprehensive history taking and physical examination as well as best practice recommendations for blood sample collection to ensure the reliability of results. This review also includes an examination of various currently available point of care tests and a comprehensive discussion on indications, limitations, and interpretation of these tests.
RESUMEN
This article is issued from a reflective approach developed from a case observed during the internship of Dr Van Nieuwenhove in the neuro-resuscitation department of the intensive care unit of the Geneva University Hospitals (Switzerland) in July 2018. This article sought to analyse the similarities and differences between two major attitudes towards assisted deaths, namely euthanasia in Belgium and assisted suicide in Switzerland. The relevant legislations and ethical considerations are presented with the value at stake in these particular end-of-life management. The whole reflective process discussed here is based on the assumption that the patient has made the request to die or had requested the end of his suffering. The reflections and questions are therefore only simple speculations allowing to open a discussion.
Cet article est issu d'une approche réflexive développée à partir d'un cas observé durant le stage de formation médicale du Dr Van Nieuwenhove dans le Service de neuroréanimation de l'Unité des soins intensifs des HUG en juillet 2018. Il cherche à analyser les similarités et différences entre deux attitudes majeures à l'égard des décès assistés, à savoir l'euthanasie en Belgique et le suicide assisté en Suisse. Les législations pertinentes et les considérations éthiques sont présentées dans ce cas particulier de gestion de fin de vie. La totalité de la réflexion abordée dans cet article est basée sur la simple considération que le patient ait formulé la demande de mourir ou, du moins, la fin de ses souffrances. Les réflexions et les questions soulevées sont donc de simples spéculations permettant d'ouvrir la discussion.